1. Most infants will drink 2-6 oz of formula/breast milk per meal, and will drink every 1-3 hours. The baby will decide how much is enough-- don't deny an infant food. If s/he eats more, she will likely spit up more, that's ok. Don't let a neonate go >4 hours without food.
2. "wry neck" aka congenital torticollis, can be due to in-utero malposition or birth trauma, due to shortening of one of the SCM muscles. SCM is shortened, resulting in head being turned towards unaffected side and tilted towards the affected side, and sometimes well feel tight/have a calcified portion. Since the baby tends to turn its head one way, it may result in asymmetric head shape from lying preferentially on one side/in one way. Tx is to stretch it for by purposefully turning towards unaffected side and massaging the muscle for 30-60 seconds, multiple times a day (i.e. every time you change the diaper).
3. At 9 months, a child should be able to clap its hands/wave bye bye, have a pincer grasp, sit up on its own, crawl, say mama/dada, and is beginning to become afraid of strangers. This can make the exam more difficult, because baby is afraid of you: sit them in parents' lap for exam. They should be sleeping through the night; if baby is waking up wanting to be fed in the night, tell parents not to feed til morning. Put baby back to sleep in crib when it's tired but not yet asleep, that way baby will learn to fall asleep on its own (i.e wont be dependent on being rocked to sleep by parent).
You draw blood for:
-CBC to check for anemia, since 6-9 months is when their iron stores from mom run out). If breast feeding, should start supplementing iron at 4-6 months 1mg/kg/day.
-Lead results. No level of lead is "ok" but we aim for a blood lead level <5. If it's over 10, then the state will send people to examine the house. BLL>45 can be associated wtih lethargy, anorexia, decreased activity, vomiting, abd pain, constipation, anemia. BLL>70: acute encephalopathy, comna, seizures, ataxia, behavioral changes. Over 30s-40s, treat with succimer (DMSA). Over 70, treat with EDTA/dimercaprol. If a kid comes in with a high lead level, x-ray them to look for lead in their GI tract. If there are paint chips in their belly, chelation is pointless and will only encourage greater absorption. Most common sources of lead: paint chips, window frames, soil (from leaded gasoline and demolition of old buildings), pipes. Lead poisoning more common in kids with iron deficiency.
4. At 2 months, baby should be able to hold its head up off the table, follow an object past midline (eyes don't focus til ~4 months), coo, recognize faces and have a social smile. Infants can see black, white and red but not other colors well. At 2 month visit, they should be vaccinated with: oral polio, DTaP, Prevnar (13-valent pneumococcus), hep B, HiB. No flu shots. No water since that can lead to hyponatremia.
5. When doing a well-baby checkup, ask about
(1) developmental milestones  (2) eating (breast vs formula, how much, how frequent) (3) wet diapers - should be >6/day (strength of urination), BM- should be >1-4/day (color, consistency-- tell them to call docs if poo is black, red, or clay-beige colored). (4) home safety (car seats, smoke detectors, pets, cigarette smoke in the home)
When doing an infant exam, check fontanelles, red reflex, ears, neck for LN, clavicle, abdomen for masses, femoral pulses, testicular descent (boys), diaper rash, spine, reflexes- moro, babinksy.
6. Car safety for kids:
Infant-2 years: rear facing carseat in back,\
Age 2-4 years/up to 40 lbs: forward-carseat, \
Age 4-8 years/til 4'9": booster seat, age 8+/4'9"+: seat belt.
Can't sit in the front until age 13.
7. Obesity leads to type 2 DM in children, sleep deprivation may compound the risk. In children younger than 10, most DM is type 1 with type 2 being rare, but the ratio of type 2 gradually increases as you go up in age from 10-19
8. Rashes in kids: often eczema or contact dermatitis. Treat with topical steroids: high- and low-potency depending on the severity of the breakout. No high-potency steroids on face or groin: skin is thinner and more sensitive. Higher systemic absorption, darkening. Psoriasis is rare in children, usually presents as guttate after strep. Seborrheic keratosis common in infancy (cradle cap) but rare afterwards.
0. Causes of childhood rash:
First disease: measles
Second disease: scarlet fever
Third disease: rubella
Fourth disease: n/a
Fifth Disease: parvo- erythema infectiosum
Sixth disease: roseola (HHV-6/7)-- assoc with high fever (38.5-40.5) for 3-5 days, followed by maculopapular blanching rash. Assoc with bulging fontanelles and febrile seizures (assoc with 20-30% of first febrile seizures in children)
Others: RMSF, VZV/chickenpox, mumps, rhinovirus, allergic rxn to pencillins
10. Small umbilical hernias are common in children of color (up to 80%).